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General NPI Number Information
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NPI Number | 1730860784
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Entity Type | Organization
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Legal Business Name | DANIELS FAMILY COMMUNITY HEALTHCARE LLC
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3716 HILLSDALE RD
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City | BALTIMORE
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State | MD
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Zip | 21207-7639
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Country | US
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Telephone | 443-985-6615
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Fax |
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Provider Business Mailing Address
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Address Line | 9005 MARCELLA AVE
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-3911
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Country | US
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Telephone | 443-985-6615
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/ NP
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Name | KHYANNE MCCUTCHEN
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Credential | NP
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Telephone | 443-985-6615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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